Provider Demographics
NPI:1144542721
Name:MELONE, MITCHELL
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:MELONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HONEY LOCUST CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6253
Mailing Address - Country:US
Mailing Address - Phone:631-253-2878
Mailing Address - Fax:516-358-7096
Practice Address - Street 1:749 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2515
Practice Address - Country:US
Practice Address - Phone:516-354-3545
Practice Address - Fax:516-358-7096
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY036557OtherPHARMACIST LICENSE NUMBER NEW YORK